Imaging Recommendations for Temporomandibular Disorders (TMD) and Orofacial Pain

Panoramic imaging may be considered for initial imaging of patient with TMD disorders to rule out gross osseous abnormalities, but it may not be sufficient for definitive temporomandibular joint (TMJ) diagnosis.^1,89

CBCT is the preferred imaging modality to assess the bony components of the TMJ, such as degenerative joint disease, idiopathic condylar resorption, arthritides or developmental abnormalities.^1,89,90

Multidetector computed tomography (MDCT) or CBCT is preferred for suspected condylar fracture or trauma to characterize fracture location, displacement, associated hard tissue injury (Figure 10).⁸⁹ MRI is preferred for suspected soft tissue trauma like the presence of adhesions or detection of hemarthrosis.^91-93

MRI should be used for definitive assessment of soft tissue pathology, including disc displacement, joint effusion and inflammatory changes. T1 (proton density-weighted) MRI is recommended for disc morphology and position.¹ T2-weighted MRI is recommended for joint effusion.^89,92

TMJ internal derangements are common and do not require imaging unless functionally limiting.¹ Open- and closed-mouth MRI imaging is recommended for evaluation of TMJ disc displacements.^89,93

Imaging should only be used when clinical findings suggest a need for further investigation or treatment planning and not as a routine part of TMD diagnosis.^93,94

Referral to a medical or dental specialist is recommended when orofacial pain is suspected to be of non-TMD origin and non-odontogenic origin such as neurovascular, neurogenic, neoplastic, systemic infectious or other secondary causes.¹ Advanced imaging modalities like MRI, MR angiography, MDCT, positron emission tomography (PET) may be indicated on the basis of the suspected etiology to support accurate diagnosis and management.^93-95